Provider Demographics
NPI:1003090457
Name:GAURANG B SHAH, MD, PSC
Entity Type:Organization
Organization Name:GAURANG B SHAH, MD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAURANG
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-625-0045
Mailing Address - Street 1:2025 CORPORATE DR
Mailing Address - Street 2:STE 1
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8884
Mailing Address - Country:US
Mailing Address - Phone:859-625-0045
Mailing Address - Fax:
Practice Address - Street 1:2025 CORPORATE DR
Practice Address - Street 2:STE 1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8884
Practice Address - Country:US
Practice Address - Phone:859-625-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32532174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7974Medicare PIN